Humboldt County, Nevada

Health Care

A number of folks in Humboldt County have expressed complaints about our local hospital, but they should be thankful for the secular hospital we have available to serve our population. Given the merger-mania in corporate America, we could be facing, like so many other communities, a takeover of our hospital by Catholic Hospitals of America and the imposition of OBGYN-lite policies, restricting the availability of reproductive healthcare services to women throughout the hospital’s service area.

Here’s a post an article from ThinkProgress that will walk you through how religious institutions are imposing their religious beliefs on women through the limited care they’re willing to provide, essentially elevating their religious rights at the expense of any patient’s rights.

When Rita, a Michigan-based OB-GYN, learned that the hospital where she worked would be switching hands, she was dismayed.

The secular community hospital, Crittenton, had plans to join with Ascension Health, a prominent Catholic nonprofit hospital chain. Rita, who asked that her real name be withheld to protect her identity, knew the transition would profoundly impact her ability to do her job the way she saw fit. The OB-GYN specifically wanted to work at a place where she could practice the full scope of reproductive care, from preventing pregnancy to delivering babies. But now, with the hospital merger looming in the not-so-distant future, that possibility seemed increasingly unlikely.

Rita also understood the change in leadership meant that her patients’ medical options would be limited. That’s because Catholic hospitals follow a set of rules written by the U.S. Conference of Catholic Bishops, which often prohibit doctors from performing basic reproductive services — like contraception, sterilization, in vitro fertilization, abortion — and end-of-life care.

Although Rita knew certain services at the hospital would soon be banned, many of her patients had no idea. They also may not have known that mergers like Crittenton’s are becoming increasingly common.

As hospitals throughout the country struggle with financial woes, many have begun to merge with Catholic systems in order to stay in business. This means a growing number of patients are winding up in institutions guided by religious doctrine. Between 2001 and 2016, the number of hospitals affiliated with the Catholic Church increased by 22 percent. Today, one in six patients in the U.S. is cared for at a Catholic hospital — a troubling trend for health care providers like Rita, who worry that patients are increasingly being placed in centers that provide services based on faith rather than medical necessity.

“I do think as more places are being purchased by Catholic systems it’s going to become more of a problem,” she told ThinkProgress. “To take away the ability to provide services that people need or desire… I think it’s very upsetting both for an OB-GYN and also for a woman. Having those choices gives you the ability to participate in society.”

Rita found another job before the Catholic system moved in. Although she says her decision to leave Crittenton was based on other factors, she admits she probably would have sought employment elsewhere even if those reasons hadn’t come up. Before Rita departed from the hospital, though, she warned her patients about what was to come — and encouraged them to get their tubes tied before it was too late.

As Rita was advising her patients to move forward with their procedures, organizers with the American Civil Liberties Union of Michigan were trying to gin up support for a campaign opposing the Crittenton merger. In June, they arranged an event at a public library in a nearby town to talk about what the shift in leadership would mean for community members. But only six people showed up. “It was so hard for us to connect to anyone who cared,” said Merissa Kovach, a field organizer in charge of the campaign.

The struggle to engage people who could be directly impacted by Crittenton’s transition might not be entirely surprising given the demographic makeup of Rochester, which is predominantly white, conservative-leaning, and upper-middle class. But it suggests another problem that Kovach and others have been struggling to address: A widespread lack of awareness about a conflict that’s quietly brewing in the health care industry. It’s a trend that has managed to accelerate rapidly and yet evade public scrutiny. Because Catholic hospitals aren’t required to disclose their religious affiliation or talk about the limited medical services they may offer, many patients wind up in the dark — and don’t think about the hierarchies that govern their care until it’s too late.

In Rochester, for example, the two systems merged without much of a fuss. But just a few days after Ascension took over the hospital in October 2015, its official website changed ever so slightly. “Tubal ligations” were removed from the list of available services.

The role of Catholics in health care is nothing new — indeed, throughout the Middle Ages, it was the Catholic Church that created hospitals and hospices for the old and ill in an attempt to follow Jesus’ teachings about healing the sick. Many of the earliesthospitals in America were set up by Ursuline sisters and other Catholic orders dedicated to serving the poor. About 75 Catholic hospitals had been established in the U.S. by 1875.

But there has been a particular boom in the number of Catholic hospitals since the beginning of the 21st century, according to a groundbreaking 2013 report on the growth of Catholic hospitals and health systems by MergerWatch, a patients’ rights organization that tracks hospital mergers, and the American Civil Liberties Union (ACLU). In 2001, about 8.2 percent of the nation’s acute care hospitals were Catholic nonprofits. By 2011, that number had jumped to 10.1 percent. This increase coincided with notable drops in the numbers of other nonprofit hospitals and public hospitals.

This trend is accelerating among all hospital chains, too, and not just nonprofits. A recently released 2016 update found that 14.5 percent of all acute care hospitals are now Catholic-owned or affiliated (up from 11.2 percent in 2001) and that four of the nation’s 10 largest hospital systems are Catholic-sponsored. Some of the growth is the result of new Catholic hospitals opening their doors — but many were the result of secular hospitals merging with Catholic systems, bringing them under the Catholic hospitals umbrella.

But while Lois Uttley, MergerWatch’s director, believes Catholic hospitals do deliver “excellent care” in many treatment areas, she and her group are working to shine a light on a major exception. They believe Catholic hospitals prevent many women from getting the reproductive health care they need — even procedures that are medically necessary — ultimately putting them in an untenable situation once they walk through the doors of one of these religious facilities.

Once a hospital elects to merge with the Catholic system, it agrees to obey a set of directives issued by the U.S. Conference of Catholic Bishops. Called the “Ethical and Religious Directives for Catholic Health Care Services” (ERDs), these rules include instructions that Catholic care “should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination: the poor; the uninsured and the underinsured; children and the unborn; single parents; the elderly; those with incurable diseases and chemical dependencies; racial minorities; immigrants and refugees.”

Although these large Catholic hospital systems operate in accordance with religious values and doctrine, they aren’t directly funded or controlled by the Catholic Church. As Uttley put it, “they are not being funded by the envelope my mother used to put in the collection basket every Sunday.”

Instead, as tax-exempt nonprofit corporations, they are funded through a combination of private insurance reimbursement, Medicare and Medicaid payments, and sometimes government grants, according to Uttley.

By bringing many hospitals together into large Catholic health systems, they can cut costs through shared administration and joint purchasing, offering protection to hospitals in rural states where isolated health care facilities often struggle. “It’s to their credit, they’ve kept these hospitals operating in very challenging times,” she said.

CREDIT: DYLAN PETROHILOS

But the directives also include prohibitions on abortion, even when a woman’s health is at risk; assistance with surrogacy; egg and sperm donation; contraception; and temporary or permanent sterilization, with few — if any — exceptions. And the condoning of or participation in euthanasia or assisted suicide “in any way” is expressly verboten for all who work at a Catholic health care institution. MergerWatch, the ACLU, and the handful of other organizations that track this issue believe these directives often mean even procedures needed to mitigate serious health risk to the patient are unavailable at a Catholic hospital.

The groups also pointed to a troubling lack of transparency: Because Catholic hospitals often choose not to disclose which services are not offered, patients don’t always realize they operate any differently from a secular institution.

Proponents of the Catholic hospital system say the distinction should already be obvious to patients given the facilities’ religious presentation. As the attorney for one Catholic hospital in California that refuses to perform tubal ligation argued in a lawsuit earlier this year, “no one is lacking for understanding that this is a Catholic hospital, from the crucifix in the front entrance to everything about it.”

But that’s not necessarily how providers see it. Nancy, a physician who provided services at Rochester’s Crittenton before the merger and continues to do so today, said the now-Catholic hospital is presented to the public as a secular institution with no disclosure of its restrictions. “I think it is incredibly difficult to understand what limits we have available,” said Nancy, who asked that her real name be withheld because she is still practicing in the field, noting that the names of Catholic hospitals don’t always reveal their religious affiliation. “It’s not Saint Crittenton. It’s not Mary of Christ Crittenton. It’s just Crittenton.”

Ascension and Crittenton did not respond to a ThinkProgress inquiry about their practices. A spokesperson for the Catholic Health Association, which represents hundreds of Catholic hospitals and facilities nationwide, said his group “encourages transparency from Catholic hospitals regarding the services they do and do not offer.”

But Brigitte Amiri, senior staff attorney for the ACLU’s Reproductive Freedom Project, says in practice, that transparency is often absent — putting patients in potentially perilous situations when they’re in urgent need of care.

“The hospital closest to you might be Catholic, you might not know it, you might not think to ask these questions until [you’re facing] an emergency situation or far along in a pregnancy,” she said.

Rachel Miller found herself in that exact situation when she was a patient at Mercy hospital in Redding, California in 2015. Miller, who was pregnant with her second child, was certain she didn’t want to have more kids: In 2013, she had an emergency C-section for her first daughter, and knew she would have to repeat the procedure for the birth of her second child. After she discussed her options with her OB-GYN, she decided a tubal ligation made the most sense — she could get it right after delivering her baby and it wouldn’t require an additional hospitalization.

Miller sent a request to Mercy for the procedure, and assumed it would be approved. Instead, she received a letter back stating Mercy would be unable to accommodate her, citing the Catholic bishops’ directives.

Miller had never heard of the directives before — in fact, she had no idea that the standard of care at Mercy would be any different than what was available at a secular hospital. “I guess if someone had asked me at the time, ‘is this a Catholic hospital?’ I would have said yes, because it’s Mercy, normally a Mercy hospital is Catholic,” she told ThinkProgress. “But I had never thought about it. And as far as Catholic hospitals in general and having ERDs, I had never thought about that either.”

Miller was sure she wanted to get her tubes tied, but after Mercy’s rejection, she found that her options were limited. Redding has only one hospital with a labor and delivery department and the nearest hospital Miller could find that took her insurance was some 160 miles away. That was out of the question — Miller knew she would have to stay at the hospital for several days, and she didn’t want to be away from her toddler for that long. Mercy — the largest hospital provider in California — was her only option, and they just wouldn’t budge.

That was especially concerning to Elizabeth Gill, an attorney at the ACLU of Northern California who later took up Miller’s case. “It’s troubling that your access to health care in such a significant degree in a state like California is dictated by the moral code that corporations subscribe to, especially given that these are entities that are largely state and federally funded,” she said.

The predicament Miller found herself in is becoming increasingly common.

For many patients, Catholic hospitals are now so ubiquitous they may be the closest or only option for care. According to MergerWatch’s most recent report, more than 40 percent of the acute care beds in Alaska, Iowa, Wisconsin, Washington, and South Dakota are in Catholic-owned or affiliated hospitals, and more than 45 Catholic hospitals in the country provide the only acute care in their geographic region. Naturally, this impacts the services available to patients. As Miller experienced, the bishops’ guidelines often prevent doctors from performing tubal ligations after patients deliver, which is the safest time for the procedure.

Moreover, as the National Women’s Law Center noted in a complaint to the Centers for Medicare and Medicaid Services, many Catholic hospitals don’t follow the medical standards of care for what’s known as “miscarriage management,” often by denying services to women experiencing pregnancy complications before viability or in the middle of a miscarriage.

Tamesha Means was 18 weeks pregnant when she showed up at a Mercy hospital in Michigan in December 2010. Her water had broken prematurely. Hospital staff examined Means, but neglected to tell her that the fetus she was carrying had virtually no chance of survival — and in fact posed a risk to her health if she continued to carry it. Means was sent home, but she returned the next day as her bleeding and cramps intensified. Again, she was instructed to go home. Means returned for a third time that night — visibly in pain and showing signs of an infection. The hospital prepared to send her home once again, but stopped when she started delivering. The baby died shortly thereafter, and the hospital staff told Means to prepare funeral arrangements.

The ACLU took on the case, arguing that the directives prevented hospital staff from informing Means of the risk of the pregnancy and directly placed her in harm’s way. “Because of the Directives, MHP did not inform Ms. Means that, due to her condition, the fetus she was carrying had virtually no chance of surviving, and continuing her pregnancy would pose a serious risk to her health,” the lawsuit claimed. As a result, “Ms. Means suffered severe, unnecessary, and foreseeable physical and emotional pain.”
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CREDIT: DYLAN PETROHILOS/SHUTTERSTOCK

The restrictions on care don’t present a burden for patients alone — working within the system can also weigh heavily on providers who are prevented from performing the full range of medical care they expected to practice as an OB-GYN. According to a 2012 national survey, more than 50 percent of OB-GYNs who work at Catholic hospitals said they’ve run into conflicts with their institutions over the directives. Dr. Didi Saint Louis, a physician in the Southeast who completed her medical residency at a Catholic hospital, is familiar with that tension herself. She remembered seeing a patient who fell extremely ill at an early stage in a nonviable pregnancy. Saint Louis was prohibited from terminating the pregnancy — even though the fetus would not survive — and ended up transferring the patient to another hospital.

“I remember our director riding in the ambulance with the patient, she went straight to the operating room, they terminated the pregnancy, and she was fine,” she recalled. “But it could have gone so many different ways. And while the Catholic hospitals strive to give the best standard of care, this is one area where I think they fall short.”

The impact of a hospital merger can be much more profound for people living in geographically isolated regions without easily accessible alternatives. According to MergerWatch, there are 46 hospitals nationally that provide the only short-term acute care for people in their region, leaving people who lack transportation and travel resources with few alternative options.

Nancy, the physician from Michigan who works with Ascension, says she’s fortunate to be in a region with more than one hospital. “I’m in an area in which my patients can commute or get to a different location, so people in more remote areas are stuck without that,” she said. “Which is a really disturbing trend.”

About 2,000 miles west of Rochester, a Catholic hospital merger brought a very different outcome. In Washington, a battle was waged over the fate of Vashon Island’s only health clinic. Vashon, a quirky island community near Seattle, is home to about 11,000 people, 45 miles of shoreline, and an unofficial mayor who was re-elected in 2015 over a goat named Bandit. It is a Democratic bastion: Mitt Romney received a mere 18.6 percent of the vote in the 2012 elections, to Barack Obama’s 77.6 percent.

In 2012, Mark Benedum, the CEO of the island’s health clinic, announced the board had decided that, due to financial struggles, the time had come “to explore the benefits of joining a larger system.” It reached an agreement to become an affiliate of Franciscan Health System, a chain of Catholic health facilities and part of the behemoth Catholic Health Initiatives.

Benedum initially claimed patients’ options would be unaffected by this union, insisting, “it’s not going to change a thing.”

Vashon’s residents weren’t so sure. A group of skeptics, calling itself Vashon HealthWatch, worried that the island’s sole clinic would now be forced to adhere to the bishops’ directives — and that their care would be limited as a result. After consulting with MergerWatch, they organized a massive town hall meeting where members of the community could question Franciscan and Highline leadership.

On April 25, 2013, weeks after the Franciscan’s purchase of the clinic was complete, about two hundred people packed the multipurpose room at one of the the island’s schools, according to Kate Hunter, who helped organized the event. It was a far cry from the sparsely attended event that took place in Michigan. And not only did people show up, but they’d read the directives and were prepared with specific questions.

Benedum and executives from Franciscan Health Services were peppered with two hours of anxious inquiries from community members about the merger’s impact on available reproductive health and end-of-life services.

Margaret Chen, a staff attorney with the ACLU of Washington Foundation, said this level of civic engagement is atypical. “The visibility of concerned citizens was large in the Vashon Island community, maybe in part because of the unique situation [of being so separated from other options].” This response, she suggested, might have been part of the reason the new ownership agreed to continue offering birth control, family planning, and contraception to patients on the island — though a company spokesperson said the directives are “consistently applied” across all of its facilities.

While the executives sought to assure residents that “nothing is going to change at the Vashon medical clinic,” Hunter wasn’t convinced. She recalled one particularly concerning exchange toward the end of the forum: “Does your contract with your doctors specify that they will follow the directives?” a resident asked. “Yes, they do,” the Franciscan representative answered. “Our employment contract does.”

John Jenkel, who is part of the Vashon-Maury Health Collaborative, a community group that works to improve emergency care options on the island, said the relationship between the new ownership and residents was scarred by that early tension. “[T]hose directives and the manner in which the Franciscans communicated with the community caused a rift that never really made for a comfortable working relationship on our small island,” he said. “The initial discussion that the Franciscans had with the community was a rocky one, and the relationship of the directives to the type of care the Franciscans would be providing was never too clear.”

Hunter stopped going to the Vashon clinic. “I just feel so strongly that no one’s religious beliefs should interfere with my health care and I had no confidence that that would not be the case at the clinic anymore,” she said. Instead, she travels to a secular nonprofit facility in Seattle, via ferry and bus — a 60- to 90-minute trip each way.

When ThinkProgress reached out to Franciscan for comment, spokesperson Scott Thompson said that “none of the practice’s women’s reproductive services changed at the clinic after Highline’s affiliation with CHI Franciscan Health.” However, he added that the Vashon Island clinic would be closing in August. The company attributed the decision to the cost of operating the clinic and the fact that visits had declined from about 1,000 a month when they took it over to between 750 and 850 a month today.

Kate Hunter laments that with the closing, “there will be no health care clinic on Vashon Island. We’re back to ground zero.”

The bishops’ directives were last updated in 2009 and, according to observers, are due to be revised again in the near future. Reproductive rights advocates say a revision could loosen restrictions on how hospitals that become Catholic through mergers may deal with reproductive decisions — or could put the kibosh on the limited flexibility that Catholic chains have shown in places like Vashon Island.

Sara Hutchinson Ratcliffe, domestic program director for Catholics for Choice, fears it will be the latter. “I think the upcoming regulations are going to close those avenues for alternative provision for those health care services, to make the partnership agreements even more strict on who must/must not do this or that,” she said. “I think it will make it worse.”

MergerWatch’s Lois Uttley is a bit more optimistic. “We hope that they will be realistic about the fact that, in this day and age, Catholic hospitals are serving everyone in the community, not just Catholics. And they are employing doctors and staff that come from a wide background of religious affiliation,” she said. “We hope there will be a recognition that all hospitals, including Catholic ones, are licensed to serve the whole community.”

The press office for the U.S. Conference of Catholic Bishops did not respond to a ThinkProgress inquiry about their timetable for an update. But when and if the directives are updated, they could make a huge difference in terms of whether doctors at hospitals that merge with Catholic hospital system.

In the meantime, several approaches have been contemplated for how to address the topic.

The Center for Inquiry, which advocates for a secular society, thinks that the Medicare and Medicaid funding Catholic hospitals receive could be used as leverage to force Catholic hospitals to provide a full range of reproductive health and end-of-life care. Michael De Dora, who heads the Center’s Office of Public Policy, explained that while he does not believe all individual doctors should be forced to engage in all health care services, all hospitals should. “The responsibility should be with the hospital in any case [if] they’re receiving public funds,” he said. “That is the ideal.”

The ACLU’s Brigitte Amiri noted that some — though not many — states have considered legislation that would shield doctors from punishment, should they choose to provide services forbidden under the directives. After non-discrimination laws and same-sex marriage equality were enacted, severalCatholic Charities organizationsshelvedadoption services rather than serve same-sex couples.

Thus far, the ACLU has concentrated its efforts on the judicial system, threatening and bringing lawsuits under the federal Emergency Medical Treatment and Active Labor Act and state medical laws. Twosuitsweredismissed at the trial court level, though both are being appealed, and others are still working their way through the courts. In April, for the first time, the 41,000 doctors of the California Medical Association announced they would join an ACLU of Northern California case against a Catholic hospital system that bars its doctors from performing tubal ligation.

Since these and other attempts to force Catholic hospitals to provide services have not yet been met with much success, some activists have focused on making the rules more transparent.

Washington state enacted a requirement that hospitals generally disclose what services they refuse to provide to the state government — which would become public record — but MergerWatch’s advocacy coordinator, Christine Khaikin, observed even that “leaves a lot of room for interpretation to the hospital system,” and few hospitals have reported much of anything.

CREDIT: AMERICAN ATHEISTS

The American Atheists, a group that advocates for a strict separation of government and religion, have circulated a piece of model state legislation called the Patient’s Right to Know Act. The organization’s national legal and public policy director Amanda Knief said it would simply require that providers “inform their patients up front of all services they’re not going to provide, according to their religious, philosophical beliefs.” This “sunshine law” would not require hospitals to provide an explanation or a referral, she added, but simply a disclosure of which services are not provided there “because we’re Catholic affiliated, or we’re Pastafarian affiliated, or we don’t believe in modern medicine.”

The bill has been introduced in Arizona, and Knief is hopeful other states will soon follow. But, she acknowledges, it may have trouble gaining momentum — some progressive groups have been reluctant to back the measure because it lacks a requirement that the hospital refer the patient to a place that performs procedures prohibited by the directives.

In some communities, MergerWatch has partnered with local advocates to utilize state hospital merger laws and galvanize public actions to force accommodations or block the mergers entirely. “Frankly, totally stopping the merger is our fallback position,” Lois Uttley explained. “What we try to do, from the outset, is make sure that community access to needed reproductive health care services is preserved in some way.” She pointed to one case in which a separately funded and staffed reproductive health care center was opened on the second floor of a newly Catholic hospital that could no longer provide all services under the directives. In another, the community got a local hospital to call off its plans to affiliate with a Catholic system.

But, like with Crittenton Hospital in Michigan, these mergers often fly under the radar. Because the hospitals themselves do not highlight that they are going to begin restricting services, MergerWatch, the ACLU, and a small number of other organizations are often the only early-warning system for communities. And, as Sara Hutchison Ratcliffe of Catholics for Choice pointed out, until more people understand what these mergers mean, it can be an uphill battle for them to galvanize community resistance.

“Awareness isn’t the only solution, but it is the first step,” she said. “Until they are aware, the likelihood of something happening is small… The first step is getting those who have the power to change it involved.”

The fate that awaits Rochester, Vashon, and the numerous other communities that have recently experienced hospital mergers is uncertain. Indeed, some may choose to go the path of resistance favored by Washington’s quirky island community, organizing themselves and arranging well-attended town hall meetings. But, as Merissa Kovach and her coworkers at the ACLU of Michigan experienced while organizing their campaign, getting that community buy-in is often an uphill battle.

“One of the biggest issues with this is that it’s just not well-known at all and nobody understands what these hospitals are doing,” Kovach said. “We’re in such a public education step with this, and it’s such an unknown issue. People don’t know why they should care.”

But why did they seem to know and care in the Washington island? At least some portion of the differences between the two community responses can likely be drawn along political lines — Vashon overwhelmingly leans left, Rochester tilts right. But what took place in the Michigan city might be the more standard course of events: A merger takes place in a community that isn’t predisposed to fight it — or isn’t even aware that it might impact the care they expect to receive — and, as was the case with Rochester, a new merger quietly goes into effect. And the cumulative impact of these mergers, critics say, is an overall reduction in available reproductive services.

CREDIT: DYLAN PETROHILOS

So what are the alternatives to Catholic medical care? In some rural communities, there aren’t any — it’s a Catholic system or nothing at all. That’s a sobering reality for people on all sides of the debate, including reproductive health advocates. They recognize that a singular focus on the expansion of the Catholic health care system ignores the forces that often propelled them to step in in the first place. Public hospitals are struggling, and their Catholic counterparts can provide much-needed care. According to the most recent MergerWatch report, the number of public short-term acute care hospitals in the U.S. dropped an astonishing 34 percent between 2001 and 2016. The number of secular nonprofit hospitals, too, shrunk by 11 percent, while for-profit systems shot up by more than 50 percent. In rural areas, where it is harder to turn a profit, these trends have left tremendous disparities in health care access.

Catholic hospitals help fill some of that gap — but at what cost? The ACLU’s Brigitte Amiri worries that hospitals’ fealty to the directives over the standard of care means that for some, the delta between the services they seek and those that are available is becoming a gulf.

“We don’t want to take away health care services from a community that desperately needs them,” she acknowledged. “But I don’t think we can be so timid about our work that we don’t push them to provide health and lifesaving care to women.”

Backed by key women’s health and civil liberties groups, 178 House Democrats on Tuesday sent a letter to Republican Speaker Paul Ryan demanding he disband an anti-choice investigative panel that has been issuing subpoenas to abortion providers and medical researchers around the country.

Women’s health and academic freedom advocates have long warned that the panel could have a chilling effect on both the provision of healthcare and university research.

But the panel’s “pattern of reckless disregard” has only escalated, according to House Democrats, with Republican members sending 36 subpoenas to researchers and healthcare providers, including a physician who was recently identified by name.

“From the beginning, Chair Marsha Blackburn has used her unilateral subpoena power to intimidate scientific researchers, doctors, clinics, health care providers, universities, and other entities,” reads the letter, which asks Ryan to respond in writing no later than June 6, 2016.

“On May 11, 2016, the majority reached a new low when it posted a press release identifying a doctor and his clinic by name,” the letter continues. “The press release’s hyperbolic rhetoric and misleading allegations pose a real danger to the doctor, the staff at the clinic, and the patients of the named clinic. These recent steps are completely outside the bounds of acceptable Congressional behavior. We disgrace ourselves by allowing this misconduct to continue.”

The most recent subpoenas are only the latest in a series of aggressive tactics that constitute a virtually unprecedented abuse of Congressional power, perhaps only matched by the McCarthy hearings of the 1950s. To this day, the Panel still lacks credible evidence to support its case that any federal laws were broken. Yet the Chair and majority staff continue to harass individuals, researchers, clinics, and health care facilities, issuing a total of 36 subpoenas so far, often without reaching out to the subject of the subpoena to ask for voluntary compliance first or without giving subjects sufficient time to comply. Congress simply has no business “prosecuting” these unfounded allegations.

The danger posed by the Panel is real and serious. There is a long and undeniable history of violence against women’s health care clinics, physicians, and patients. As recently as November 27, 2015, a gunman murdered three people and injured nine others at a Planned Parenthood clinic in Colorado Springs, repeating the “baby parts” rhetoric pushed by the very members of Congress leading this investigation. Despite this horrific event, the same inflammatory language has been used repeatedly during Panel hearings, in communications with the press, and in other documents. The majority has also refused to take necessary steps to protect the names and privacy of those subject to the investigation. Indeed, some names and targets have already been publicly disclosed. We are deeply disappointed by the majority’s decision to continue down this road despite these well-known risks.

In a statement on Tuesday, the ACLU expressed support for the Democrats’ call.

“By issuing broad and baseless subpoenas,” said Louise Melling, the ACLU’s deputy legal director, “the Select Investigative Panel is not only wasting time and taxpayer money, but also violating the civil liberties of health care providers, medical researchers, and staff. This panel’s actions are clearly meant to harass and intimidate healthcare providers to prevent them from providing constitutionally protected care women need.”

And there are even more insidious goals in play, said Ilyse Hogue, president of NARAL Pro-Choice America.

“By promoting falsehoods in order to close clinics, the Select Panel has been endangering women, students, researchers, and health care providers since it was formed,” Hogue said in a statement on Tuesday. “House Democrats are right to call on Speaker Ryan to disband this committee and put a stop to its taxpayer-funded witch hunt.”

The panel and its actions, she said, offer “one more example of the anti-choice GOP’s reckless disregard for safety of women and the priorities of most Americans.”

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The law, colorfully labeled the “Protecting Unborn Children Amendments,” requires abortion providers who perform “an abortion of an unborn child who is at least 20 weeks gestational age” to administer an anesthetic or analgesic to eliminate or alleviate organic pain to the unborn child.” The law’s supporters claim that human fetuses are capable of feeling pain around the twentieth week of pregnancy, and that this bill will help eliminate that pain.

This claim about fetal pain, however, is scientifically dubious at best. According to a paper published by the Journal of the American Medical Association, scans for electrical activity in fetal brains suggest that “the capacity for functional pain perception in preterm neonates probably does not exist before 29 or 30 weeks.” As the same paper explains, fetal pain awareness “requires functional thalamocortical connections,” yet the brain fibers necessary to allow such connections do not start appearing until “23 to 30 weeks’ gestational age.”

Utah law typically prohibits abortions around 22 weeks into a pregnancy, when the fetus is deemed viable. Thus, that state’s new law will primarily impact women who seek abortions during a narrow two-week period.

It is as if Utah required women to consume a small dose of strychnine before they can receive an abortion.

And, while deaths are rare, serious complications ranging from nerve damage to “malignant hyperthermia” can result from anesthesia. Anesthesia can also cause long-lasting mental defects. According to Scientific American, studies “suggest that a high enough dose of anesthesia can in fact raise the risk of delirium after surgery,” and that “even if the confusion dissipates, attention and memory can languish for months and, in some cases, years.” (Though it should be noted that these mental side effects are especially likely to occur in elderly patients that are past childbearing age.)

As one doctor told the AP, “you never give those medicines if you don’t have to.” Now, however, thanks to this Utah law, doctors will have to.

That is, of course, unless the courts strike down the Utah law. Under Roe, states gain greater authority to regulate — or even ban — abortions as a pregnancy progresses. Yet, even in the latest stages of pregnancy, the health of a woman seeking an abortion has primacy. Abortion is always permitted “where it is necessary, in appropriate medical judgment, for the preservation of the life or health of the mother.”

Since Roe, however, the Supreme Court has carved away much of the right protected by that decision. Most notably, in Gonzales v. Carhardt, the Court upheld a ban on a method of abortion that was viewed by many doctors and medical associations as the safest method “for women with certain pregnancy-related conditions, such as placenta previa and accreta, and for women carrying fetuses with certain abnormalities, such as severe hydrocephalus.” Thus, in effect, the Court held that lawmakers could potentially make abortion less safe for many women who seek it.

Even after Gonzales, however, the Utah law is a significant escalation in the war against Roe. AfterGonzales, a woman who sought an abortion was still likely to receive a procedure that, in their doctor’s medical opinion, was the safest legal option — even if the single safest procedure was no longer legal. The majority opinion in Gonzales also claimed that “there is medical and scientific uncertainty” regarding whether to procedure at issue in that case was ever the safest medical option.

The Utah law, by contrast, imposes additional risk on women seeking abortions, despite the fact that there does not appear to be any medical benefits to subjecting a woman to unnecessary
anesthesia or narcotics. It is as if Utah required women to consume a small dose of strychnine before they can receive an abortion. If the dose is small enough, it probably won’t kill the woman, but the state would still be exposing women to a very dangerous chemical without any health-related reason to do so.

On March 24, the Congressional Budget Office, or CBO, published data that surprised even the staunchest advocates for health care reform: New estimates show that total federal spending in fiscal year 2016 for major health care programs will be lower than was projected back in January 2009. Why is this shocking? The January 2009 projections did not include the Affordable Care Act, or ACA, which was not signed into law until March 2010. This means that federal health programs are covering more people while spending less money.

Though the ACA coverage expansion added new costs, total spending for federal health programs is still less than what the CBO projected in January 2009 because of huge savings from Medicare. In fact, the CBO’s projections for FY 2016 Medicare spending have fallen $107 billion since January 2009. A portion of the Medicare savings can be unambiguously attributed to the ACA.

The House GOP-dominated Budget Committee held 9 hour markup, with several lawmakers going hoarse and one losing her voice. Democrats offered up 29 amendments, involving immigration reform, prescription drug prices, and equal pay. Every amendment failed, including one proposed by Rep. Debbie Dingell [D, MI-12] that would have designated $457.5M in emergency funding for Flint and required Michigan to match the federal funds. The budget advanced 20-16, with Democrats voting against and all but one Republican voting for the measure. Here’s their summary:

Balances the Budget

Balances the budget within 10 years – without raising taxes – and puts the country on a path to paying off the national debt

This budget achieves $7 trillion in deficit reduction over ten years through a combination of $6.5 trillion in savings coupled with economic growth

Savings are higher than any previous House Budget Committee proposal and discretionary spending is below 2008 levels

Requires consideration of legislation this year to achieve at least $30 billion in automatic spending reductions and reforms over the near term

Advances budget process reforms to promote fiscal discipline, and calls for a vote on a Balanced Budget Amendment this year

Strengthens Our National Defense

Provides for greater security at home and strength abroad at funding levels above the president’s budget and with increased resources for training, equipment and compensation

Supports the bipartisan prohibition on closing the Guantanamo Bay detention facility and transfer of detainees to American soil

Identifies vulnerabilities in our nation’s refugee program and calls for oversight and rigorous screening

Calls for an improved and accountable Department of Veterans Affairs that can better deliver services and benefits to our veterans

Empowers Our Citizens & Communities

Promotes job creation and a healthier economy by calling for a fairer, simpler tax code, regulatory reform, expanded energy production, and a more efficient, effective and accountable government

Saves, strengthens, and secures Medicare for current and future retirees (read the Q&A carefully as to HOW they intend to do that)

Empowers states and local communities with the flexibility to innovate and make improvements to Medicaid, nutrition assistance, education and other programs

Strengthens the Disability Insurance program by putting an end to the “double-dipping” loophole that currently allows individuals to receive both unemployment insurance and disability insurance simultaneously

Puts an end to corporate welfare and dismantles the Department of Commerce [that would mean they intend to help balance the budget by issuing pink slips to 43,000+ employees and ending measuring services like: Bureau of Economic Analysis (BEA), Bureau of Industry and Security (BIS), U.S. Census Bureau (Census), Economic Development Admin (EDA), Economics and Statistics Admin (ESA), International Trade Admin (ITA), Minority Business Development Agency (MBDA), Natl Institute of Standards and Technology (NIST), Natl Oceanic and Atmospheric Administration (NOAA), Natl Technical Information Service (NTIS), Operation Natl Telecom & Information Admin (NTIA), and United States Patent and Trademark Office (USPTO).

Frequently Asked Questions(Make sure you read the Q&A regarding “full” repeal of the Affordable Care Act, AND the dance they do to explain how their “voucher” approach to Medicare isn’t really a “voucher” program for their apparent privatization of our trust fund contributions)

Next week, the Supreme Court hears oral arguments in Whole Woman’s Health v. Hellerstedt, a challenge to Texas’s ambitious anti-abortion law HB2. If this law is upheld — a very real possibility in a conservative Supreme Court — Roe v. Wade would have most likely remained alive in name only. States would gain sweeping new power to shut down abortion clinics, so long as they dressed up the laws they enacted to end access to abortion as health regulations.

Except that opponents of abortion no longer have the fifth vote they need to gut Roe. Justice Antonin Scalia’s death means that Roe shall live at least another year. Whether it survives past next year, however, could very well be decided by whoever gets to fill Scalia’s seat.

AUL, moreover, does not hide its goal in pushing such legislation — as ThinkProgress’ Erica Hellerstein reported, AUL functions as a “legislation mill” producing anti-abortion bills that can be copied and enacted in many states. The anti-abortion group brags on their website that they work “through the law and legislative process to one end: Achieving comprehensive legal protection for human life from conception to natural death.” Overruling Roe v. Wade, according to AUL, “can be accomplished through deliberate, legal strategies that accumulate victories, build momentum, and restore a culture of life.”

Just over one week ago, Whole Woman’s Health appeared poised to become AUL’s crowning achievement. Under the Supreme Court’s 1992 decision in Planned Parenthood v. Casey, states may not enact laws that place an “undue burden” a woman’s right to choose abortion — a vague standard that’s proved quite malleable in the hands of abortion opponents. At the same time, states may legitimately regulate all medical clinics, including those that provide abortions, to protect the health of individuals who seek treatment from those clinics. Whole Woman’s Health asks what happens when a state enacts abortion restrictions disguised as health regulations.

The clinic regulations and credentialing requirements at issue in this case will do little, if anything, to advance women’s health. But they make it a whole lot harder to obtain an abortion. Thus, a decision upholding HB2 could potentially return women to a world much like the one that existed prior to Roe. States may not actually be allowed to openly ban abortion after such a decision, but they’d have broad authority to restrict abortion just so long as they are clever enough to devise anti-abortion laws that look like health laws. And if state lawmakers proved inept at this task, groups like AUL would be more than happy to give them a hand.

Now, however, with Scalia’s seat vacant and the Court evenly divided between Democratic and Republican appointees, the likelihood HB2 will be upheld outright is vanishingly small.

No Longer The Man in the Middle

Before Scalia’s unexpected death, all eyes were on Justice Anthony Kennedy, the closest thing the Roberts Court has to a swing vote on abortion. As a general rule, if your plan of attack against an abortion restriction depends on winning Kennedy’s approval, you need a better plan. Prior to HB2, Justice Kennedy considered 21 abortion restrictions as a member of the Supreme Court andallowed 20 of them to take effect. In one case, Kennedy justified an abortion restriction in part because he thought that “it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained.”

Yet, while Kennedy’s opinions reveal an almost visceral revulsion towards abortion, he’s also proved unwilling to overrule Roe outright. Kennedy co-authored the Casey opinion, which limited abortion rights, but which also purported to hold that “the essential holding of Roe v. Wade should be retained and once again reaffirmed.”

Thus, before conservatives lost their majority on the Supreme Court, the most important question in Whole Woman’s Health was likely to be which Justice Kennedy shows up to work next week — the one that consistently upholds abortion restrictions or the one that is unwilling to invalidate Roe in its entirety. Kennedy, moreover, gave hope to Team Choice when he cast the fifth vote to stay a lower court order upholding nearly all of HB2.

Uncertain Process

Now that the Court is evenly divided between liberals and conservatives, Kennedy no longer has the power to drive a nail in Roe‘s coffin, but he could still have the power to do considerable damage to the right to choose. The ordinary rule when the Court splits 4-4 is that the lower court’s decision is affirmed and the justices’ decision does not have any precedential value. Because the court of appeals largely upheld HB2, a 4-4 decision in Whole Woman’s Health would allow the Texas law to almost entirely remain in effect — at least until a fifth justice is confirmed to the Court and another abortion case reaches the justices.

Thus, as Cosmopolitan’s Jill Filipovic notes, Scalia’s death may actually make it more likely that Justice Kennedy votes to uphold HB2. “If Scalia were still alive, Kennedy might be choosing between overturning Roe and invalidating the Texas law,” Filipovic writes. Now, however, he doesn’t have to choose between two options that he’s likely to view as undesirable. Rather, if he sides with the conservatives he will leave lower court’s opinion in place without creating a precedent he may later come to regret. “For this particular justice, who seems to find abortion troubling but may not want to see it outlawed wholesale,” Filipovic notes, “that may be a desirable outcome.”

There is, however, some uncertainty about whether Kennedy will have this option. As SCOTUSBlog’s Tom Goldstein notes, the Court’s past practice when a vacancy opened in the middle of a term was to hold cases where the justices split over until the next term, when the open seat presumably would be filled. Given the extraordinary obstructionism Senate Majority Leader Mitch McConnell (R-KY) has already planned against anyone President Obama sends up to fill this seat, it remains to be seen whether the justices will decide to hold over split decisions until next term or simply affirm the case by an evenly divided vote and be done with it.

Which process they choose could matter a great deal in Whole Woman’s Health. Recall that Kennedy provided the fifth vote to stay the lower court’s decision upholding HB2. That order provides that the stay shall last until “the issuance of the judgment of this Court.” Thus, if the Court holds the case over for reargument next term, the stay remains in effect until the Court decides the case, and HB2 does not go into effect. If the Court affirms the lower court by an evenly divided vote, by contrast, that counts as a “judgment” of the Supreme Court, so the clinics most impacted by HB2 will close.

The choice whether to hold the case over could also matter for an entirely different reason. If President Obama (or a similarly minded president) manages to fill Justice Scalia’s seat, one of the first matters taken up by the Court’s new liberal majority would be a major abortion case. That would not only give them the opportunity to strike down HB2, it would also give them the chance to expand a right to choose that has been gradually chipped away after decades of conservative decisions. The vague “undue burden” standard that now controls abortion cases was pushed by abortion opponents including the Reagan Justice Department and AUL itself before it was ultimately adopted by the Supreme Court. A more liberal Court could scrap this standard altogether or, at the very least, clarify it in a way that does not permit anti-abortion judges to take advantage of its vagueness.

Rather than becoming AUL’s crowning achievement, in other words, Whole Woman’s Health could be their most demoralizing defeat.

Yet that outcome depends entirely on who gets to fill Justice Scalia’s seat. If the next justice is more like Scalia, Whole Woman’s Health could still become AUL’s greatest triumph.

For months, government officials in Michigan have been scrambling to address the fallout of the man-made water catastrophe in Flint that poisoned thousands of mostly low-income people of color. While many Americans believe that racism can be boiled down to a sin marked by slurs and men burning crosses under the cover of night, Flint serves as a stark reminder that racism is in the air we breathe, flowing freely into our homes.

— a request from Hillary Clinton

For two years, the people of Flint, Michigan, complained that their water was murky, that it smelled bad, that bathing in it gave them rashes — and for two years, they were told they were wrong, and that their water was safe. But it wasn’t. It was poisoned, and the children of Flint were drinking it.

I traveled to Flint last weekend at the invitation of Mayor Karen Weaver to talk with residents and community leaders. The people I met were passionate, thoughtful, and tireless — one 6-year-old came to our meeting, and his mom spoke about how she’d tried so hard to shield her son from the ills of the world, only to learn she’d been giving him baths in poisoned water.

What happened in Flint is the cruelest kind of indifference, and an affront to what we stand for as a nation. Clean water is not optional, and it’s not a luxury — it’s a basic human right. The children of Flint are just as deserving of bright futures as the children of any other community. And today, those children need our help.

If you can, please chip in to support the Flint Child Health & Development Fund, which is working to provide health care and educational support to families in Flint affected by this crisis. We know that lead poisoning can affect kids for their whole lives, so 100 percent of your donation will help provide ongoing services for the next 20 years to the most vulnerable families in Flint:

We need to keep talking about Flint, and we need to make sure that every child in this country can grow up to reach his or her God-given potential — no matter where they come from, the color of their skin, or how much money their parents make. Thank you for standing with me in this fight and so many others. Thank you for doing your part to help the children of Flint.

“It is deeply fitting that Republicans chose Groundhog Day for their failed veto-override vote. Today, instead of working to create good-paying jobs or raising the paychecks of hard-working Americans, Republicans once again recycled their dead-end special interest assault on women and working families.

“Today’s failed vote represents Republicans’ 63rd vote to repeal or undermine the Affordable Care Act and their 12th vote to attack women’s health in the 114th Congress alone. With this vote, Republicans have once again tried to take family planning and lifesaving preventive care away from millions of women across America. With this vote, Republicans tried to shatter the affordable health care of 22 million Americans.

“Again and again and again, the Republican Congress returns to these toxic, hollow bills. House Republicans’ self-declared ‘factory of new ideas’ is stuck in a miserable remake of Groundhog Day – and the women and working families of America aren’t laughing. The American people need the Republican Congress to set aside their radical obsessions and join Democrats to grow their wages and strengthen their security for the future.”

Note: All three of Nevada’s Republican members of the US House voted FOR passage of the bill to override President Obama’s veto of HR 3762. Their efforts failed.

After the 62nd vote to repeal “Obamacare” (the Patient Protection and Affordable Care Act) which has now been upheld by the Supreme Court TWICE, the Republiban members of Congress finally managed to pass HR 3762. Inaptly named, the bill that would have done the exact opposite of its title: “Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015.” Restoring “Americans'” freedom? Nope! More like restoring the freedom for Insurance Corporations to give Americans the short shrift related to any hope of accessing healthcare insurance and thus health care itself.

And just so you know, each and every Nevada Republican in the House of Representatives, Rep. Mark Amodei (CD2), Rep. Joe Heck (CD3), and Rep. Cresant Hardy (CD4) voted FOR passage of HR 3762 (as well as a large number of previous bills) which would not just repeal the Affordable Care Act for millions of Americans who can barely afford health insurance as it is, but would have also revoked any and all funding received by Planned Parenthood by folks who not only can’t afford health insurance, but can’t afford health care either. Senator Dean Heller also voted FOR passage(repeal) in the Senate in December preceding the vote in the House.

Today, at the stroke of his pen, President Obama showed us exactly HOW important it is that we have a Democratic President in the oval office as he promptly and unceremoniously vetoed their wasted efforts. Here’s his message back to Congress:

TO THE HOUSE OF REPRESENTATIVES:

I am returning herewith without my approval H.R. 3762, which provides for reconciliation pursuant to section 2002 of the concurrent resolution on the budget for fiscal year 2016, herein referred to as the Reconciliation Act. This legislation would not only repeal parts of the Affordable Care Act, but would reverse the significant progress we have made in improving health care in America. The Affordable Care Act includes a set of fairer rules and stronger consumer protections that have made health care coverage more affordable, more attainable, and more patient centered. And it is working. About 17.6 million Americans have gained health care coverage as the law’s coverage provisions have taken effect. The Nation’s uninsured rate now stands at its lowest level ever, and demand for Marketplace coverage during December 2015 was at an all-time high. Health care costs are lower than expected when the law was passed, and health care quality is higher — with improvements in patient safety saving an estimated 87,000 lives. Health care has changed for the better, setting this country on a smarter, stronger course.

The Reconciliation Act would reverse that course. The Congressional Budget Office estimates that the legislation would increase the number of uninsured Americans by 22 million after 2017. The Council of Economic Advisers estimates that this reduction in health care coverage could mean, each year, more than 900,000 fewer people getting all their needed care, more than 1.2 million additional people having trouble paying other bills due to higher medical costs, and potentially more than 10,000 additional deaths. This legislation would cost millions of hard-working middle-class families the security of affordable health coverage they deserve. Reliable health care coverage would no longer be a right for everyone: it would return to being a privilege for a few.

The legislation’s implications extend far beyond those who would become uninsured. For example, about 150 million Americans with employer-based insurance would be at risk of higher premiums and lower wages. And it would cause the cost of health coverage for people buying it on their own to skyrocket.

The Reconciliation Act would also effectively defund Planned Parenthood. Planned Parenthood uses both Federal and non-federal funds to provide a range of important preventive care and health services, including health screenings, vaccinations, and check-ups to millions of men and women who visit their health centers annually. Longstanding Federal policy already prohibits the use of Federal funds for abortions, except in cases of rape or incest or when the life of the woman would be endangered. By eliminating Federal Medicaid funding for a major provider of health care, H.R. 3762 would limit access to health care for men, women, and families across the Nation, and would disproportionately impact low-income individuals.

Republicans in the Congress have attempted to repeal or undermine the Affordable Care Act over 50 times. Rather than refighting old political battles by once again voting to repeal basic protections that provide security for the middle class, Members of Congress should be working together to grow the economy, strengthen middle-class families, and create new jobs. Because of the harm this bill would cause to the health and financial security of millions of Americans, it has earned my veto.

The Republiban may have used procedural shenanigans to enable them to pass HR 3762, but to override President Obama’s veto, the Republiban would need a two-thirds affirmative vote on repeal bill. The don’t have that. This was all for show for the rabid GOP base heading into the November election. But more than that, it’s a serious red-flag warning to Democrats that if we don’t overwhelm the polls this November to begin taking back Congress, and instead all the Republiban to hold onto Congress plus, take the White House, you can kiss the American Dream goodbye and buy the coffin as it will truly be dead.

Officials from Republican Texas Governor Greg Abbott’s administration have raided Planned Parenthood health centers across the state, demanding the confidential records of women who visited the health centers, including ultrasound records. The news is especially alarming for a state with an extensive history of criminalizing abortion.

Turn up the heat on vulnerable Republican senators running for re-election next year by holding events outside their in-state offices and running powerful social media campaigns targeting them for waging a war on women.

Run a hard-hitting media campaign to expose the attacks on Planned Parenthood for what they are: propaganda designed to close down health clinics and ban abortion.

Ramp up campaigns in the next set of states where Republicans are going after Planned Parenthood funding.

We simply cannot allow anti-abortion extremists to destroy an organization that helps so many people—or to roll back women’s rights and access to health care.

Planned Parenthood is under an all-out assault. But our fighting back has made a huge difference, including helping stop bills to defund Planned Parenthood in the U.S. Senate. Specifically:

I recently traveled to Washington, D.C., where I met in person with Senators Elizabeth Warren and Harry Reid to bring them 1.2 million signatures from MoveOn members and key partners supporting Planned Parenthood.

We partnered with Planned Parenthood to organize 138 rallies and other visibility events across the country on #PinkOut Day last month.

And, on the state level, we supported numerous MoveOn members in leading petition campaigns and other organizing to stop their states from defunding Planned Parenthood.

Now, we need to show that attacking Planned Parenthood is a political loser and will cause vulnerable Republicans running for re-election next year to lose support among women. We know this strategy can work because Planned Parenthood is enormously popular. And we’ve used this strategy before and won: The Republican War on Women is a big reason why Todd Akin and Mitt Romney lost their elections in 2012.